Fractures of the medial epicondyle

　　Radial condyle fracture often occurs in children and is less common. The scope of involvement includes most of the medial epicondyle and trochlea. Its injury mechanism, type, and treatment method are very similar to those of radial condyle fracture. Therefore, the two form a symmetrical

　　The cause of most fractures of the medial epicondyle is due to indirect violence.

　　Pathogenesis

　　The majority of injuries caused by indirect external forces occur when the palm of the hand touches the ground after a fall, with the force transmitted along the forearm to the elbow, where the olecranon joint surface collides with the trochlea, potentially leading to a fracture. It can also be due to the elbow being屈曲 when landing, accompanied by stresses that cause the distal end of the humerus to invert, leading to a collision between the olecranon and the trochlea and resulting in a fracture. In addition, a fracture of the medial epicondyle may be a avulsion fracture, similar to an epicondylar fracture. As for the specific way the olecranon collides with the trochlea, it may also be due to the rotation of the ulna, with the olecranon's semilunar notch impacting the medial side of the humerus horizontally.

　　Fracture of the humeral medial epicondyle is the most common type of elbow injury, more common in adolescents, accounting for about 10% of elbow fractures, ranking second only to supracondylar fracture of the humerus and fracture of the lateral epicondyle of the humerus, and accounting for the third place among elbow injuries.

　　Fractures of the humeral medial epicondyle can be complicated by elbow joint subluxation. Fractures of the humeral medial epicondyle can also be associated with other injuries, such as radial head, neck, and olecranon process fractures. In addition, since the fracture of the humeral medial epicondyle is both an intra-articular fracture and an apophyseal injury, failure to reduce the fracture satisfactorily not only hinders the recovery of joint function but may also cause growth and development disorders, leading to limb deformities (such as elbow varus) and traumatic arthritis. In some severe cases, complete dislocation of the fracture fragments can occur, leading to ischemic necrosis of the fracture fragments.

　　Clinical manifestations of elbow joint subluxation:

　　1. Special manifestations of dislocation Obvious deformity of the elbow, fullness of the elbow fossa, the appearance of the forearm becomes shorter, the olecranon process of the ulna is prominent posteriorly, the posterior part of the elbow is empty and concave. The joint is elastically fixed at 120 to 140 degrees, with only a small degree of passive mobility. The relationship of the bony landmarks at the back of the elbow changes. Normally, when the elbow is extended, the olecranon process of the ulna and the proximal and distal epicondyles of the humerus form a straight line; when the elbow is flexed, it forms an isosceles triangle. In dislocation, the above relationship is destroyed. In the case of supracondylar fracture of the humerus, the triangular relationship is maintained normally, and this sign is the key to distinguishing the two.

　　2. Complications of elbow joint dislocation Posterior dislocation sometimes is accompanied by ulnar nerve injury and other nerve injuries, fracture of the olecranon process of the ulna, and in anterior dislocation, it is often accompanied by fractures of the olecranon process of the ulna, etc.

　　3. X-ray examination of the elbow joint in anteroposterior and lateral views can show the type of dislocation, associated fractures, and distinguish them from supracondylar fractures.

　　Fractures of the medial epicondyle of the humerus are more common in children than in adults. After injury, there is swelling of the soft tissues around the medial side of the elbow and the proximal ulna, or the formation of a large hematoma. Clinical examination shows the existence of the isosceles triangle relationship of the elbow joint, with the patient presenting with pain, especially local swelling and tenderness on the medial side of the elbow. The outline of the normal proximal ulna disappears, the range of motion of the elbow joint is limited, the forearm pronates, the wrist and fingers are weak, and in cases of associated elbow joint dislocation, the appearance of the elbow joint is significantly changed, and the dysfunction is more obvious. It is often accompanied by symptoms of ulnar nerve injury. The type of injury is similar to that of the lateral epicondyle of the humerus, and the fracture is divided into three degrees.

　　Ⅰ Fracture: The fracture is non-displaced, with the fracture line extending obliquely from the superior medial epicondyle to the trochlear joint below.

　　Ⅱ Fracture: The fracture line is similar to that of type I, with the bone fragments having lateral or slightly upward displacement, but without rotation.

　　Ⅲ Fracture: There is obvious rotational displacement of the bone fragments, most commonly rotation in the coronal plane, which can sometimes reach 180 degrees, causing the fracture surface to be completely facing medially. It can also rotate in the sagittal plane, leading to the fracture surface facing posteriorly, while the trochlear joint faces forward. Sometimes, the ulna can move medially along with the fracture fragments, leading to a partial dislocation of the elbow joint. Diagnosis: Swelling and pain of the elbow joint, limitation of extension and flexion, marked tenderness on the medial side of the joint, sometimes palpable bone friction, and X-ray films of the elbow joint in anteroposterior and lateral views can confirm the diagnosis, especially the anteroposterior view.

　　Radial condyle fracture is the most common type of elbow joint injury, more common in adolescents, accounting for about 10% of elbow joint fractures, ranking second after supracondylar fracture of the humerus and radial condyle fracture, and occupying the third place in elbow joint injuries.

　　In terms of prevention, since this disease is caused by traumatic factors, attention to production and life safety and avoiding trauma are the key to preventing the disease.

　　For patients receiving treatment, attention should be paid to functional exercise. The joint function exercise device can be used for postoperative recovery exercise (CPM), which can slowly flex and extend the elbow joint, eliminate the resistance of protective pain muscle contracture, and achieve good results step by step. For children with joint fractures, passive functional exercise should be emphasized, especially in the younger age group, and active activities are secondary.

　　Radial condyle fracture often occurs in children and is less common. The scope of involvement includes most of the medial epicondyle and trochlea. Its injury mechanism, type, and treatment method are very similar to those of radial condyle fracture. Therefore, the two form a symmetrical

　　The diagnosis of this disease includes detailed inquiries about the history of trauma, clinical manifestations, and some physical examinations. For patients with clinical suspicion, additional X-ray films of the opposite elbow joint should be taken. Sometimes, the positive

　　Anteroposterior X-ray films can show the direction of the fracture line, the size of the fracture fragments, and the degree of displacement; lateral X-ray films can indicate the anterior and posterior displacement of the fracture fragments. During X-ray diagnosis, it must be noted that before the ossification center of the radial condyle of the child appears, the fracture in this area should be judged according to other anatomical landmarks, such as the position changes of the radial head, the radial condyle, and the radial styloid process. If necessary, X-ray films of the same side elbow joint in the same position should be taken for comparison. In order to observe the difference, it is necessary to take the opposite side elbow joint in the same position, so as to compare and observe.

　　The treatment principle for radial condyle fracture is to determine the treatment method according to different fracture types, displacement degree, and the general condition of the patient. Most cases can be treated by traditional Chinese medicine manipulation reduction. After reduction,配合中药调理, has a significant effect on promoting fracture healing. In addition to drug regulation, diet also plays a crucial role.

　　What foods are good for the body with humeral condyle fractures?

　　1, Early stage (1-2 weeks): The injured part has ecchymosis and swelling, meridians and collaterals are blocked, Qi and blood are stagnant. The treatment during this period focuses on promoting blood circulation and removing blood stasis, and dispersing Qi and dissipating. According to traditional Chinese medicine, 'If the blood stasis does not go away, the bone cannot grow' and 'if the blood stasis goes away, new bone grows'. It can be seen that removing blood stasis and dissipating is the primary task for fracture healing. The principle of diet coordination is to focus on light food, such as vegetables, eggs, soy products, fruits, fish soup, lean meat, etc.

　　2, Middle stage (2-4 weeks): Most of the ecchymosis is absorbed. The treatment during this period focuses on harmonizing the camp, relieving pain, removing blood stasis, and promoting new growth, and reinforcing bones and tendons. In terms of diet, it turns from light to moderate high-nutrition supplementation to meet the needs of bone callus growth, and can add bone soup, Tianqi braised chicken, animal liver, and other foods to the initial diet to provide more vitamin A, D, calcium, and protein.

　　3, Late stage (more than 5 weeks): After 5 weeks of injury, the ecchymosis of the fracture site is basically absorbed, and there is already bone callus growth, which is the late stage of fracture. Treatment should be supplemented, through the nourishment of the liver and kidney, Qi and blood, to promote the formation of a more solid bone callus, and to relax the tendons and collaterals, so that the adjacent joints of the fracture site can move freely and flexibly, and restore the past function. Diet restrictions can be lifted.

　　What foods should be avoided for humeral condyle fractures?

　　(1) Early avoidance of sour, spicy, dry, and greasy foods. It is especially not advisable to take greasy and nourishing tonics prematurely, as this may delay the course of the disease, slow down the growth of callus, and affect the recovery of joint function in the future.

　　(2) Avoid eating too much pork bone. Eating too much pork bone by fracture patients not only cannot heal early, but also may delay the healing time of the fracture.

　　(3) Avoid malnutrition. The key to the smooth healing of fractures is nutrition.

　　(4) Avoid indigestible foods. Fracture patients are restricted in activity due to the fixation of plaster or splints, and added to the swelling and pain at the injury site, mental anxiety, so the appetite is often poor, and constipation occurs from time to time.

　　(5) Avoid excessive consumption of sugar. After excessive intake of sugar, it will cause a rapid metabolism of glucose, thus producing intermediate metabolites such as pyruvate and lactic acid, causing the body to present an acidic poisoning state.

　　(6) Avoid long-term use of Sanqi tablets. Taking Sanqi tablets in the early stage of fracture can contract local blood vessels, shorten coagulation time, and increase thrombin, which is very appropriate. However, after one week of fracture reduction, if Sanqi tablets are continued to be taken, the local blood vessels are in a state of contraction, blood circulation is not smooth, and it is not beneficial to the healing of the fracture.

　　(7) Prohibit drinking fruit juice. The raw materials for fruit juice are made up of sugar water, flavoring, pigments, etc. It does not contain the vitamins and minerals needed by the human body. Because it contains a lot of sugar, it presents a physiological acidic state in the body after drinking.

　　The treatment principle for humeral condyle fractures is to determine the treatment method based on the type of fracture, degree of displacement, and general condition of the patient. Most cases can be treated by manual reduction.

　　Non-displaced type I fractures are treated by using a long arm splint to fix the elbow joint in flexion 90° and pronation of the forearm for 4 to 5 weeks, and then remove the splint for functional exercise. During this period, a photo review is conducted once a week. If the fracture has displacement, appropriate measures should be taken.

　　1. Closed Reduction and External Fixation

　　Type II and III fractures should be reduced by closed reduction, using local anesthesia or brachial plexus anesthesia. The assistant places the injured limb in a 90° elbow flexion, and the forearm in pronation position. The operator's palm muscle supports the lateral side of the elbow joint, and the other hand uses the thumb to press the displaced bone piece into reduction. After reduction, the palm muscle is used to support the medial side of the elbow, corresponding to the medial condyle of the humerus, and pressure is applied to the radial side above to maintain reduction. It is fixed with a long arm splint or a super-joint small splint pad, and the external fixation is removed for functional exercise after 4-5 weeks.

　　2. Percutaneous撬拔复位固定

　　If closed reduction fails, under the monitoring of the X-ray machine television screen, a Kirschner wire is inserted from the upper inside of the bone piece through the skin, the tip of the needle stops at the bone piece, corrects the rotational and lateral displacement and pushes the bone piece outward until anatomical reduction. Then, select another Kirschner wire to pierce the skin from the inside below the medial condyle to fix the medial condyle to the proximal end of the fracture. Bend and cut off the needle tail and bury it under the skin or leave it outside the skin, fix it externally with a cast, and remove the needle and remove the cast for functional exercise after 4-5 weeks. If this method fails, open reduction and internal fixation should be performed immediately.

　　3. Open Reduction and Internal Fixation

　　Applicable to patients with treatment failure or redisplacement of the above conditions, the operation takes an incision on the medial side of the elbow, pays attention to protect the ulnar nerve, clears the hematoma or granulation tissue at the fracture site, determines the direction of the fracture displacement after reduction, and reduces the fracture block. If it is difficult to reduce due to the traction of the flexor muscle, the soft tissue attached to the bone piece can be appropriately stripped but must retain the tenodesis site to avoid the free bone block from ischemic necrosis. After the reduction of the fracture, internal fixation can be performed with two small Kirschner wires or cancellous bone screws, or the fracture block can be fixed by passing silk thread through the bone hole. After the operation, the cast is fixed, and the cast is removed for functional exercise after 4-5 weeks.

　　Old fractures are very difficult to reduce, as the cortical bone of the intercondylar fossa of the distal humerus is very thin, it is difficult to determine the direction of the original fracture surface. Therefore, the surgical treatment should be based on the degree of elbow joint dysfunction. Those with obvious dysfunction usually can be treated by elbow joint release surgery. For those with obvious valgus deformity of the elbow, osteotomy of the supracondylar humerus can be performed.